The OIH Paradox: Can Opioids Make Pain Worse?

In an early essay describing his clinical observations of patients injecting morphine on a daily basis, physician/author Clifford Albutt [1870] wondered, “Does morphia tend to encourage the very pain it pretends to relieve?” He continued, “I have much reason to suspect that a reliance upon hypodermic morphia only ended in a curious state of perpetuated pain” [p. 329]. Although this was essentially ignored in subsequent clinical research at that time, questions about the pain responses of opioid-dependent patients again arose with the advent of methadone maintenance treatment for addiction in the 1960s [Ho & Dole 1979; Martin & Inglis 1965], and culminated in current understandings of what is described as opioid-induced hyperalgesia (OIH) –– that is, diminished tolerance for pain following opioid administration [see reviews Angst and Clark 2006; Mao 2002; Ossipov et al. 2005].


Author(s) Compton, P. and Levitt, S.
Attribution Courtesy of
Document Download PDF
Share This